Marijuana Use in Pregnancy: Implications for State Laws

Not surprisingly, there was quite a strong response to my previous blog about marijuana use in pregnancy, in which I discussed the long term deficits in executive functioning in children and adolescents prenatally exposed to marijuana. I received many supportive comments, but there were several replies that were downright venomous and some a tad threatening! Makes one wonder what the writers were smoking when they responded to the column. In any case, I stand by my previous statement.

And now, a brand new study has come out of NIH, published in Obstetrics and Gynecology, documenting that marijuana use in pregnancy places a pregnancy at two times increased risk for stillbirth: death of the fetus at or after 20 weeks gestation. This was a huge study across 59 hospitals nationwide. All women in the study had a blood test for cotinine—a breakdown product of nicotine—and the fetal umbilical cords were tested for several types of drugs, including cocaine, methamphetamine, prescription painkillers, and marijuana. The women also answered a survey regarding their drug use patterns during pregnancy. Based on all these data, women who smoked marijuana were 2.3 times more likely to have a stillbirth than women who did not smoke marijuana during pregnancy. Why is this important? Because the United States has one of the highest stillbirth rates (6 per 1,000 births) among developed nations of the world, affecting 26,000 newborns in this country each year.

There will remain many proponents for smoking marijuana in pregnancy, but for my part, I have a few questions. Do any of the newly passed state laws allowing the medical use of marijuana or legalizing marijuana altogether consider precautions that should be taken to warn pregnant women against its use? Are physicians advised to ask a woman seeking a prescription for marijuana when her last period was or if she could possibly be pregnant? Is a pregnancy test recommended before writing such a prescription? Is the general public aware of the risks associated with marijuana use in pregnancy? The answer to all these questions is a resounding no.

Don’t get me wrong. I am very much in favor of medical marijuana laws. Marijuana has earned its place in the pantheon of medications that can relieve suffering, especially among patients going through the rigors of chemotherapy, AIDS, glaucoma, certain aspects of chronic pain, and other debilitating conditions. But we have to at least recognize that marijuana’s use during pregnancy has its own risks, and we need to incorporate guidelines into the new and emerging marijuana laws that recognize and communicate that risk. Marijuana use is fast fading from the legal agenda, but its use, especially during pregnancy, remains a public health issue.

Use of marijuana during pregnancy places the pregnancy and the child at risk.

The "child"? Sorry doc, but I agree with the other commenter above. Women have every right to own their bodies and decide what they want to do and what is best for them. If a pregnant woman smokes pot, what are you going to do, charge her with "child" abuse? Of what "child" do you speak, exactly? Last I checked, we in the States do (for now) still have a little thing called Roe v. Wade on the books, which established that the woman's bodily autonomy takes precedent over bullshit existential fears of what may happen to her hypothetical "child." The law says that a fetus -- the proper term -- is not a "child" until 20 weeks into the pregnancy; I would contend that the definition should not be used until the head pops out. Belgium and the Netherlands recognize that the infant is a "child," but give authority for postnatal euthanasia to the MOTHER for up to a year if the infant turns out to have disabilities or an otherwise impaired quality of life. Once again, authority and autonomy goes where it should and doesn't have anything to do with BS moral garbage about what women should or shouldn't be allowed to do. (I see no criticism of men smoking pot and altering their sperm.)

But I guess you have no problem with, say, a cancer-stricken pregnant woman ingesting powerful chemo drugs that cause nausea and other unbearable side effects (which can be ameliorated with use of cannabis), as long as she doesn't do any naughty "illegal" drugs -- which more often than not come from farms and not factories. I am sick and tired of this pro-natalist garbage being trotted out in this day and age. Now we've got a bona fide shrink crying think of the children? Which aren't even technically "children" but amorphous lumps of snot? Where the fuck did this author go to medical school? The Vatican? Bob Jones? Afghanistan?

I too am a woman. If a woman knows she is pregnant (or suspects that she may be pregnant) and then consciously chooses to engage in extensive, frequent recreational drug/alchohol use, then she is committing a form of physical abuse on her developing fetus in my opinion.

A developing fetus is likely to be born (if it survives at all) with severe physical and/or mental defects if the mother engages in such behaviors.

So in my opinion in areas where marijuana is available as a legal prescription drug, it should be treated like *any other legal prescription drug*: there should be sufficient regulation, quality control, tracking of use/prescription refills, etc.

Doctors are trained to know that some medications are absolutely prohibited for women who are pregnant, likely to become pregnant, or breast-feeding because there ARE substances/chemicals that are well known to cause birth defects or harm a nursing infant.

IF that also pertains to marijuana, it should become public knowledge. (The public has heard of thalidomide causing birth defects, and alcohol causing fetal alcohol syndrome, as a couple of examples.)

My own personal opinion is that a woman who knowingly puts her fetus at risk should be charged with child maltreatment when the infant is born horribly deformed or otherwise damaged, suffering and in pain due to the presence of drugs/alcohol during development.